View all news

How can our primary care estate help with addressing inequalities?

The UK is one of the wealthiest countries in the world, the fifth largest economy overall in terms of GDP[1]. But this wealth is primarily held by a small number of wealthy individuals[2], while more than 1 in 5 of the population are in poverty[3] and experiencing significant and increasing health inequalities[4] – a situation exacerbated by the impact of COVID-19. All of our large urban centres exemplify this: in Plymouth, the difference in life expectancy drops from 84 years and 10 months in the Plympton Chaddlewood ward to 77 years and 1 month in St. Peter and the Waterfront ward[5].

As evidenced by COVID, those living with these levels of inequality are those who are most vulnerable to illness, crisis, limited quality of life and early death; interventions to support them as this late stage comes at significant cost to the whole of society, and to the health and care system in particular[6]. Addressing these inequalities has to be a critical focus for the whole of civil society, including the NHS. This challenge is recognised in the Health and Care Act, which includes an enhanced focus on addressing health inequalities[7].

The 2010 Marmot report[8] identified the following social determinants of health and made recommendations as to how they should be addressed:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop healthy and sustainable places and communities.

Activities and programmes to implement these recommendations, address health inequalities and support healthy and resilient individuals, families and communities sit largely outside the NHS, including through community-led activity, local voluntary, community and social enterprise (VCSE) organisations and by local authority services, with health services contributing only an estimated 30% towards someone’s health and wellbeing compared to these wider social determinants for health. However, the current, largely private, ownership structure of the NHS primary care estate means that much of it is either poor quality and inappropriate or comprises high quality, expensive, inflexible and poorly utilised ‘sickness’ centres, used only when someone is ill or in crisis.

Imagine instead that we might create ‘centres of health in our communities that address the full range of health determinants. These will differ from place to place…. That’s why we need to resource health at local levels and in doing so, fully embrace every model of delivery that is likely to promote wellbeing, as well as narrowly-defined clinical health.

If we have a broad definition of health then we will also need to have a broad definition of what community-based approaches look like, both in terms of buildings and open spaces. They might not look like health centres. They might be owned by patients. Clinical health may just be 30% of what goes on inside them. They might not be driven by the NHS.[9].

The opportunity of new ownership models allows the NHS to work with residents, patients and other stakeholders to create community hubs, that:

  • Are animated by – and with a sense of ownership by – local residents
  • meet their needs and aspirations,
  • operate as catalysts for health and wellbeing and the resilience of residents, families and communities
  • provide a range of activities, services and programmes that locally address the social determinant of health, and:
  • have the right range of health and care services to support them in times of illness and crisis.

Now, perhaps this something for us to work together towards….

Mark Harrod
Mark Harrod

Mark Harrod, is the founder and director of KYMA Consulting; Programme Director for Barking Riverside Health & Wellbeing Hub; Member of the Plymouth Pioneer Project Team, leading on Strategic Case for Change and development and implementation of the Model of Care programme.

This work includes the planning for growth, Towns Fund bids and capital integration opportunities to improve health outcomes.

  1. “World Economic Outlook Database, April 2021”. IMF.org. International Monetary Fund. April 2021.
  2. ‘Richest 1% have almost a quarter of UK wealth’: Resolution Foundation https://www.resolutionfoundation.org/app/uploads/2020/12/The-UKs-wealth-distribution.pdf
  3. https://www.jrf.org.uk/report/uk-poverty-2020-21
  4. Inequalities in life expectancy have widened since 2010. The difference in life expectancy at birth between the least and most deprived deciles was 9.5 years for males and 7.7 years for females in 2016–18. In 2010-12, the corresponding differences were smaller – 9.1 and 6.8 years, respectively. Life expectancy at birth for males living in the most deprived areas in England was 73.9 years in 2016-18, compared with 83.4 years in the least deprived areas; the corresponding figures for females were 78.6 and 86.3 years. Page 11. ‘Health Equity in England. https://www.health.org.uk/sites/default/files/2020-03/Health%20Equity%20in%20England_The%20Marmot%20Review%2010%20Years%20On_executive%20summary_web.pdf
  5. Plymouth Joint Strategic Needs Assessment https://www.plymouth.gov.uk/sites/default/files/Plymouth%20Report_2019.pdf
  6. Back in 2014, the Equality Trust estimated this as £37.5bn https://www.equalitytrust.org.uk/sites/default/files/The%20Cost%20of%20Inequality.pdf
  7. Page 17. https://www.kingsfund.org.uk/sites/default/files/2021-02/integrated-care-systems-London-2021_0.pdf
  8. ‘Fair Society, Healthy Lives’. http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf
  9. ‘Stop Building Health Centres’. https://www.bbbc.org.uk/wp-content/uploads/2020/04/StopBuildingHealthCentres-rebranded.pdf

Last Updated on 21 June 2022